Lipoedema

In Lipoedema, lipocytes, capillaries and venules are involved. An increased number and size of lipocytes results in increased fat volume, which causes hypertrophy and hyperplasia, increased permeability of the capillaries causes oedema, and increased fragility of venules leads to the development of a haematoma. Oedema is the main and most obvious cause of pain in people with lipoedema, so conservative therapy which reduces oedema can lessen the pain suffered. There are probably other factors causing pain, but oedema seems to be the most obvious.

Lipoedema mainly develops in adult females, but males are not affected. In most cases, lipoedema starts after puberty, a time when women want to look slim and beautiful. For some people lipoedema continues to progress until the end of life and is accentuated by pregnancy, birth and other hormonal changes, such as the menopause. In others, it remains at a steady level without progressing. The disease can also develop later in life. The condition is under-recognised due to limited medical training, overlapping symptoms with obesity or venous disease, and the absence of standardised diagnostic criteria.

At Hunar Clinic, Dr Puneet Gupta and his team are committed to raising awareness, educating both patients and healthcare professionals, and offering accurate diagnosis and tailored treatment plans and long-term management to reduce pain and discomfort.

Lipoedema is often mistaken for lymphoedema or excess weight gain. However, it has distinct clinical features:

• Symmetrical distribution: Both sides of the body are affected evenly.
• Hands and feet spared: This helps distinguish it from lymphoedema, which typically includes the hands or feet.
• Texture and feel: Lipoedema tissue feels soft, doughy, or nodular, without the pitting often seen in early lymphoedema.
• Response to lifestyle changes: Diet and exercise rarely reduce lipoedema fat, unlike typical obesity.

Understanding these differences is crucial, as misdiagnosis can delay effective treatment and worsen symptoms.

Lymphoedema exists in two distinguishable forms, primary and secondary lymphoedema.

Lymphoedema is the abnormal accumulation of lymph fluid in adipose tissues of the arm or leg. This causes a swelling in the affected limb. This has resulted from an impaired lymphatic system. The lymphatic system is a network of vessels and nodes, otherwise known as lymph glands, that drain excess waste fluids from the body’s tissues into the bloodstream.

Lymphoedema can limit mobility and cause pain and discomfort, disfigurement and distress and for infections to reoccur.

Primary lymphoedema develops as a result of rare congenital conditions with either a hereditary or non-hereditary basis; this can deform and affect the function of the lymphatic transportation system.

Lymphoedema can also occur if the lymph glands have been damaged or removed during a surgical procedure, radiation, infection or injury due to cancer. It is the most common type of chronic lymphoedema and is known as secondary lymphoedema.

An impaired lymphatic system causes a build-up of fluids, proteins and other tissue elements within the interstitial space. High levels of protein and toxins found in lymph causes a local inflammatory reaction, adipose tissue hypertrophy and fibrosis which result in swelling, loss of function, disfigurement and recurrent skin infections.

Genetic and Hormonal Factors:
Lipoedema often runs in families, suggesting a clear genetic association. The condition also shows a strong link with hormonal imbalance, as it frequently develops or worsens during periods of hormonal change — such as puberty, pregnancy, or menopause. These factors explain why the disorder predominantly affects women and why lifestyle measures alone rarely improve it.